Expensive Proton Beam Technology Booms as Its Potential Remains Unclear

For years we’ve been writing about the overuse of proton beam therapy for cancer patients. But manufacturers and the doctors who use the massive, expensive equipment it requires remain head-scratchingly gung-ho.

Proton therapy is radiation that uses high-energy beams to shrink tumors. According to the Mayo Clinic, “Proton therapy has shown promise in treating several kinds of cancer. Research of proton therapy continues, as doctors try to determine who may benefit from proton therapy treatment.”

Clearly, it’s in the development stage, so why are so many providers so keen to grow the market for this incredibly expensive procedure when its potential remains unknown? A recent report by Kaiser Health News (KHN) and NPR noted that there are 14 U.S. centers in operation, with a dozen under construction. The cost for each is about $200 million.

So some industry professionals were surprised when Indiana University announced in September that it would shutter its proton therapy facility in Bloomington. Their reaction is confusing to anyone who’s paying attention – there’s little evidence, the KHN/NPR story pointed out, that proton therapy is superior to more traditional forms of radiation for almost all types of cancer. (See our blog, “Better Care with the Tried and True, or the Seduction of the New?”)

Amitabh Chandra is a professor at Harvard’s Kennedy School of Government who studies U.S. medical care. He was among those surprised at Indiana’s announcement, even though, as he told KHN/NPR, “we do know it is substantially more expensive and substantially more lucrative for physicians and providers to use this technology.”

In the Washington, D.C. area alone, three proton therapy centers are being built – one at Johns Hopkins, one at MedStar Georgetown University Hospital and one at the Maryland Proton Treatment Center. All three D.C.-area facilities are full-speed-ahead with their plans, two of which told KHN/NPR that the D.C.-Baltimore region was sufficiently larger than Bloomington and could support the huge projects. The third told the reporters that theirs is smaller and will be more cost-effective than the others.

But Indiana’s decision wasn’t made in a vacuum. Its review committee decided that it just wasn’t worth spending the money necessary to update its facility. And even more telling, its insurers have declined to subsidize proton therapy for common diseases including prostate and breast cancers. One of its insurers, Cigna, concluded that proton therapy for all tumors except a rare eye cancer was not shown to be more effective than other forms of radiation therapy.

Given the cost of the equipment, it’s no surprise that proton beam therapy costs as much as six times what standard radiation therapy costs for prostate cancer, according to Cigna. And it’s hardly a lone voice: Other major insurers including Aetna and Blue Shield of California also limit what they’ll cover with proton therapy.

When insurance does cover expensive care that isn’t superior to less expensive options, guess what? The cost of everyone’s health care rises.

Facilities that pay for fancy equipment, and doctors who train to use it, aren’t going to sit around waiting for patients to present with rare forms of cancer – they’re going to use the equipment for which the payments are due, and they’re going to charge as much as they can for it.

Of course, the providers and researchers involved with building new proton beam facilities believe wholeheartedly in its value. They note the potential of proton therapy to kill cancer with pinpoint accuracy, sparing surrounding tissue from damage. They say that it’s just a matter of time before clinical trials prove that proton therapy is worth the extra money.

Indiana University doesn’t think so. Neither do we.

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